PEOPLE TO PEOPLE AMBASSADOR PROGRAMS

JOURNAL OF PROFESSIONAL PROCEEDINGS

Clinical Laboratory Science
Delegation to
The Republic of South Africa

Scott Aikey
Delegation Leader

October 3-13, 2011


























Delegation Briefing and Orientation
October 4, 2011
Johannesburg, South Africa

Our Clinical Laboratory Science Delegation consisted of 14 professional delegates and 0
guests:

Professional Delegates:
Scott Aikey (NJ) James Adams (NJ) Mickey Amos (CA)
Bonita Boothman (MI) Cheri Burns (TX) Corsina De Henriques (Portugal)
Mary Gourley (PA) Estolle Gross (IN) Connie Jacobs (NC)
Patricia Jensen WI) Carol Ann Jordan (PA) Lerma Narvades (CA)
Stacey Robinson (MD) Shirley Van Riper (CO)


The delegation assembled in a conference room in the Southern Sun Grayston hotel in
Johannesburg, South Africa on October 4, 2011 to meet each other as well as our tour guides.
Lizel from Spirit of Africa gave us an amazing overview of the country of South Africa. She
detailed the culture, customs and history so that we knew what to expect over the next 10 days.
Kenny Takalo, our main tour guide while in Johannesburg, also provided us the logistics detail
for the remainder of the day and coming days.



Professional Meeting: National Health Laboratory Service (NHLS)
October 5, 2011
Johannesburg, South Africa

Hosts: Kaamini Reddy, Marketing Director; Dr. Johan Van Heerden, Exective
Manager; Stelios Michas, LIS manager; Dr. Barry Kistnasamy
Discussion Leaders: Scott Aikey
Journalist: James Adams

Introduction:

Kaamini Reddy, Marketing Director, started the meeting with introductions and then gave the
floor to Professor Koornhof. An independent board of directors appointed by the Department of
Health runs the NHLS. It was formed 10 years ago by merging other organizations with the
motto of service, research, and training. They serve from 70 to 85% of the population with 323
labs and 275 sites across the country, as well as doing testing for other countries in Africa. They
do about 13.5 million tests and 72 million billable tests. The government and WHO fund testing
through fee for service but most patients dont pay.

NHLS is staffed by 7,200 professionals and services all government hospitals. They train all the
pathologists in the country and work with universities to teach and train other staff. They work
with the DOH to improve the healthcare of the general public.

The TB lab is funded by PEPFAR because of the close association with HIV. The incidence of
overlap is 1 in 100. They perform ID, quantification, and sensitivity testing. IDs are done with
line probes and BACTEC midgets are being used for sensitivity. They also conduct research
on extremely resistant TB and are looking into doing diagnostic testing with PCR.

Dr. Johan Van Heerden, executive manager of QA and accreditation, discussed their academic
platform and research activities. Nine years ago, the NHLS started working with schools of
technology to train technologists. They have an umbrella agreement to share and guide service
delivery and training of laboratory staff. Pathologists are trained for 4-5 years and they graduate
about 15-25 a year. The Health Professional Council of South Africa accredited the schools.

As for research, they have worked on about 7,870 projects and have published 373 articles. As
for QA, the labs are ISO 15189 and SANAS accredited. They are inspected once annually.
Sixty-five percent of academic labs and 15% of regional labs are accredited. The goal is to
have all labs done by 2015. There is no penalty for not being accredited or failing an
accreditation but labs are strongly encouraged to pass. They use Q-Pulse to audit and monitor
quality.

Stelios Michas, LIS manager, discussed their LIS. The NHLS is currently using a locally
developed system called DisaLab. TrakCare will replace it soon. Their system is linked to
communicate with most HIS (MediTech, Soarian, and Clinicom) systems. All provinces have
web-enabled access and use cell phone technology (MobiLABS).

Dr. Barry Kistnasamy discussed the National Cancer Registry (NCR) and National Institute of
Occupational Health (NIOH). The life expectancy in South Africa is 50-55 years. The 5 leading
causes of death are: MIs, stroke, respiratory conditions, AIDS, and COPD. Emphysema, TB,
and silicosis are increasing as causes of death along with Kaposi sarcoma and non-Hodgkins
lymphoma because of HIV. The NCR started as passive reporting but became compulsory this
year. It is used for research purposes. NIOH provides guides and training materials for
workforce safety. They contain information in lay speak in the main languages. They also use
a multimedia approach to get out messages. For the portion of the population that is illiterate,
they use face-to-face meetings.

Once the more formal presentations were concluded, the group was taken on a tour of the main
labs including the TB labs.

The Delegation poses for a picture outside of the NHLS



Professional Meeting: Lancet Laboratories
October 6, 2011
Johannesburg, South Africa

Hosts: Peter de Wet, Group Marketing Director, National Diplomate Medical
Technology
Discussion Leaders: Scott Aikey
Journalist: Cheri Burns

Overview:

Peter de Wet provided an overview of healthcare in South Africa. The population of South
Africa is approximately 50 million, but there is an additional 10 million illegal immigrants. The
borders with northern countries are very porous, so that the regional economies are more
important, than the national economy in South Africa. There is a three-tier system of
healthcare. About 7.5 million of the population is covered by some type of medical aid
insurance. There are many options available from all-inclusive plans to hospital plans to basic
plans. The individuals contribution to their healthcare depends on choice of plan. For example,
your contribution may be 10% of your pre-tax income with certain plans. Approximately 1
million individuals elect to pay for their healthcare out of pocket and have no health insurance.
Their healthcare is only limited by what they can afford or are willing to pay. Everyone else
receives his or her healthcare from state facilities. Their contribution to their healthcare
depends on their income sliding scale co-pay. The state facilities are divided into tertiary
hospitals, provincial hospitals, and rural facilities (often clinics). Currently there is a great deal
of strain on tertiary hospitals as individuals recognize that this is the source of good care and
will choose to travel great distances to go to a tertiary hospital rather than the local facility. The
government is placing emphasis on improving the trust that individuals have in the local clinics.
The state facilities provide healthcare to the majority of the population and are overburdened.
There are long cues to see physicians and obtain diagnostic testing. Physicians who practice at
state facilities receive lower pay than those practicing at private facilities. There is a movement
in South Africa toward national health care and they are looking at national health care systems
in a variety of countries to see what works and what doesnt.

Mr. de Wet discussed laboratory testing in South Africa. Laboratory testing is performed by the
National Health Laboratory Service (NHLS) (government-operated), large private reference
laboratories or private Medical Technologist-run laboratories. In South Africa, hospitals do not
operate their own laboratories, but rather contract with the NHLS or a private reference
laboratory. The reference laboratory maintains a core or stat laboratory within the hospital, but
the majority of laboratory testing occurs at the reference laboratory facility. Transfusion services
is a separate entity within the hospital. The South African National Blood Service provides
donor blood and blood products. There are three large reference laboratories: Lancet,
PathCare, and Ampath, which are private laboratories. Lancet operates in the 5 northern
provinces of South Africa and northern countries bordering South Africa like Botswana,
Mozambique, Zambia, and Zimbabwe. PathCare Laboratories operate in eastern portions of
South Africa, while Ampath operates nationally. The range of laboratory tests performed by
these facilities is similar to that performed in the US. The healthcare plan determines which test
will be paid for.

Lancet Laboratories has approximately 4200 employees. The lab employs between 80-90
pathologists. The laboratory staff includes 1000 medical technologists & medical technicians,
400 phlebotomy technicians, 1000 nurses and a large IT group. The medical technologists
have a national diploma and have passed a national certification examination. The medical
technicians receive on-the-job training and complete a national certification examination. The
phlebotomy technicians receive on-the-job training. The roles of the pathologist and medical
technologist are complementary. The pathologist reviews the laboratory results and consults
with the physicians, while the medical technologist performs the day-to-day operations of the
laboratory that surround quality laboratory testing. It is a professional relationship with the
pathologist deferring to the medical technologist when questions arise concerning the laboratory
testing and laboratory results obtained. Lancet Laboratories does provide continuing medical
education (CME) for laboratory professionals and physicians. They recently began HIV
workshops to update physicians on latest treatments for HIV. FYI overall there is 11% HIV
rate nationally, but within younger age group the rate is 35%.

Lancet Laboratories prides itself in its communication between the healthcare provider
(physician) and the pathologist and its excellent turn-around-time for test results. The
organization also has traveling nurses who perform insurance medical examinations and
provide corporate wellness days. Lancet is certified by the Health Profession Council and South
African National Accreditation System (SANAS) and meets the international criteria set out
according to ISO Standard 17025. Lancet Laboratories performs about 1.48 million tests/week.

Tour of the Laboratories:

The TB lab is a level 3 facility. There were 18 processing hoods with TB recovery determined
by BD BACTEC MGIT (mycobacterial growth system) (12 BACTECs) followed by antibiotic
susceptibility testing. With this system, TB identification and antibiotic susceptibility is
determined within 1 week. Molecular testing for TB is performed by the GeneXpert system, but
represents a second line of testing. Auromine O fluorescent stain is used to screen specimen
smears and Ziehl Neelsen stain is used for confirmation. This lab has a 10% TB positivity rate
that depends on where the specimens have come from.

Within the general microbiology lab there were different sections based on body site (e.g., stool
section, urine section, blood culture section, and normal flora section). The lab utilizes agar
plates for isolation of the organisms and the VITEK system for identification and antibiotic
susceptibility. Direct testing is performed on urine samples whose microscopic examination
suggests infection. Testing is performed by PCR. All molecular testing is currently performed in
the separate molecular diagnostics lab.

The hematology lab has Beckman-Coulter LH750 and LH500 instruments. Instruments are
under service contracts and reagent contracts with Coulter. Most CBCs are performed by the
peripheral laboratories (e.g. within hospitals), subsequently only perform 20-30 CBCs/ESRs per
day. Abnormal CBCs and differentials are received from peripheral laboratories, so more
differentials are performed per day. The Alifax Test-1 automated instrument performs the
ESRs. This system uses 5 mL EDTA collection tubes. ABO and Rh typing was also performed
in this lab. The Bio-Rad Diamed automated gel test system is used.

Within the flow cytometry lab there are 3 BD FACS Calibur flow cytometry instruments and 2
Sample Prep Assistant III (SPA III) systems. This lab performs leukemia/lymphoma panels,
lymphocyte subsets, PNH, allergy panels, and VASP for monitoring Plavix. As far as workload,
about 10 leukemia panels per day shift and a similar number on the night shift are performed.
They perform a large number of CD4 counts (600-800 per shift) in addition to South Africa,
specimens come from Uganda, Zimbabwe, and Botswana. They are evaluating placement of
flow cytometry instruments at other locations, but dont wish to use smaller instruments due to
the large volume of testing. The flow cytometry lab is going to switch to the BD FACS Canto II
instrument, which will enable them to perform 8-color analysis.

Lancet Laboratories is a full-service reference laboratory, but we didnt have enough time to visit
other discipline-specific laboratories such as chemistry, molecular diagnostics, and cytogenetic
technology.


The group dons lab coats in preparation to tour the Lancet Laboratories




Lancet Laboratories was truly a state of the art labs as seen in these pictures.





Professional Meeting:
University of Johannesburg Biomedical Technology and Microbiology
October 6, 2011
Johannesburg, South Africa

Hosts: Professor A Swart, Executive Dean, Faculty of Health Sciences; Ingrid van
der Westhuyzen, Head of Department; Professor Heidi Abrahamse, Director of
Laser Research Centre
Discussion Leaders: Scott Aikey
Journalist: Cheri Burns

Overview:

Professor A Swart, Executive Dean, Faculty of Health Sciences, began with an overview of
higher education in South Africa. Prior to 1994, there were 36 sites of higher education. In
1993 higher education was nationalized and sites of higher education were consolidated
decreasing the number of sites from 36 to 23. The Department of Higher Education mandates
that there is a separation between residential universities and distance-learning universities.
The residential universities have no online courses within their programs of study. Only short-
term online courses for continuing education are approved. The distance-learning universities
emphasize education through online courses. The University of Johannesburg is a
comprehensive university and represents the merger of 3 institutions: Rand Afrikaans
University, Technikon Witwatersrand and the Soweto and East Rand campuses of Vista
University. This merger occurred in 2005. The mission of the university is excellence in
teaching/learning and research. There are 1000 permanent faculty members and 50,000
students across 4 campuses. The universitys rank in research was 9th in 2005 and 7th in
2010. This ranking is based on journal units. The university has 9 schools or faculties: Art,
Design, and Architecture; Education; Economics; Engineering and Built Environment; Health
Sciences; Humanities; Law; Management and Science.

Like in the US, higher education is expensive and not affordable to many potential students.
The wealth gap in South Africa is the largest in the world. There is also an issue of lack of
access to higher education for many. The University of Johannesburg considers one of its
goals to provide access to all potential students for higher education. There are several
mechanisms by which a student can gain assistance with tuition/fee payments. The national
tertiary fund from the government represents monies that are available for the very poor. This
funds purpose is to widen access to higher education. Students must repay the fund and this
repayment may be accomplished by community service. There are also scholarships that are
available to students after they have completed the 1st year. The majority of students pay for
their education themselves (i.e., out of pocket). The University of Johannesburg and the Faculty
of Health Sciences have exchange programs for international students. These are post-
graduate programs and have no specific qualifications. These exchange programs are typically
3 weeks in length. There is no program for undergraduate students. Finally, the dean
emphasized that the Faculty of Health Sciences represents a profit center at the university that
is something that Schools of Health Professions at universities in the US would like to be.

The Biomedical Technology department is housed in the Faculty of Health Sciences. Ingrid van
der Westhuyzen, head of the department, discussed the educational activities that occur within
this department. There are two undergraduate programs in medical technology, the 3-year
diplomate and the optional Bachelor in Technology degree. There are about 400 applicants for
the undergraduate program in biomedical technology and 40-45 new students enter the 1st year
of the program. To be admitted to the program, student must have completed physical
chemistry, life sciences, and math courses with 50 or greater (This would roughly equate to a C
or better in the US). The 1st year of the undergraduate program consists of foundational
courses. The 2nd year consists of discipline-specific courses like microbiology or hematology.
The 3rd year consists of an integrated pathophysiology course, integrated molecular diagnostics
course, management course, and research course. During the 3rd year, a student will spend
time in each area of the laboratory: clinical pathology, microbiology, cellular pathology, and
cytogenetics (total time = 6 months). This experience gives the student an opportunity to decide
the specific area in which they wish to concentrate (i.e., complete the 1 year internship). After
completing the internship year at affiliated clinical laboratories, the students must complete the
national certification examination. The national certificate is required to practice as a medical
technologist. The biomedical technology program has a 70-80% pass rate on this exam.
Individuals have 3 opportunities to pass this examination. Certified medical technologists who
have practiced for at least two years can set up a private laboratory practice. Most often, it is a
cytopathology lab.

Professor van der Westhuyzen went on to describe the new undergraduate program that will be
offered in 2013. The new program will result in a Bachelor of Science degree in Medical
Laboratory Sciences. The program will be four years in length and will include the internship
and certification examination as part of the degree program. This program will emphasize an
integration of courses that were described for the diplomate program and include a research
project.

In addition to the undergraduate program, the biomedical technology department has a masters
program that requires a minimum of two years to complete and a PhD program which requires a
minimum of 3 years to complete.

Dr. Heidi Abrahamse, Director of the Laser Research Centre, provided an overview of research
conducted in this center. Areas of research activity include biochemical chemistry, medical
laser use (low-power laser), wound healing (e.g., in the diabetic population), and photodynamic
cancer therapy (e.g., laser activates chemical that has been taken up by the cancer cell).
Currently the Centre supports 15 post-graduates. Most of the post-graduates come from the
biomedical technology program, but some will come from a relevant science program. Post-
graduate student financial support is available. For example, there is the New Generation
Scholarship fund that awards a post-graduate student 3 million Rand. A student who received
his or her PhD from University of Johannesburg is expected to work at the university for at least
three years maintaining research and teaching activities.

Tour of the Student Laboratories and Laser Research Centre:

Ingrid van der Westhuyzen and Heidi Abrahamse lead the tour of student laboratories and the
Laser Research Centre. The student laboratories were very similar to student laboratories for
medical laboratory sciences here in the US. Students perform many manual laboratory tests,
but also have a few automated instruments, for example automated chemistry instrument.
These instruments allow students to become familiar with the operation of laboratory
instruments before they enter their internship. The Laser Research Centre has state of the art
instruments to investigate and document the effects of laser light on cell growth and
development using an Olympus virtual imaging system to view cell cultures.


Scott Aikey, Delegation Leader, presents a Certificate of Appreciation on behalf of the People to
People Organization.


The University of Johannesburg prides themselves on educating the best Medical Technologists
as well as employing top-notch faculty performing cutting edge research such as Ingrid van der
Westhuyzen


Professional Meeting: Groote Schuur Hospital
October 10, 2011
Cape Town, South Africa

Hosts: Maureen Lambrick, Laboratory Manager
Discussion Leaders: Scott Aikey
Journalist: Mickey Amos

Overview:

The delegation visited the Groot Schuur hospital which is one of the largest public hospitals in
South Africa and was the site for the worlds first human heart transplant in 1967. The
laboratory manager is Maureen Lambrick who led the delegation through a tour of the
laboratory, which is run by the National Health Laboratory Service (NHLS). The delegation only
had a short time to visit the laboratory and tour their facilities due to an ongoing laboratory
inspection.

The laboratory consists of 357 staff, 200 of which are Medical Technologists. They analyze
over 3000 samples each day, each which 3-4 tests/sample. The hospital is a 1400 bed hospital
with about 900 on average, which are occupied. The laboratory is accredited by SANAS
through ISO 15189.

The lab is state of the art and includes a specimen processing robotics line, which separates,
centrifuges and aliquots samples for testing. Various instrumentation includes those from
Roche, Abbott, and Beckman Coulter and other, all state of the art. Due to the nature of
disease in South Africa, they perform a lot of HIV related testing such as approximately 250
CD4 tests per day as well as approximately 400 HIV viral load tests/day. They also have
combined the various Molecular Biology/Cytogenetics/HLA needs for DNA with single DNA
extraction laboratory. For Cytogenetics, they act as the reference lab for cytogenetics for the
entire Western Cape of South Africa.

The laboratory participates in external Quality Assurance testing with samples coming from CAP
(United States), RCPA (Royal College of Australia) and NIQUS (United Kingdom.)



The delegation poses for a picture outside of the laboratory inside the Groot Schuur Hospital.
The Laboratory is run by the NHLS.

Scott Aikey presents a Certificate of Appreciation to the Laboratory Manager. Groot Schuur
Hospital is a massive facility with 1400 hospitals beds.








Professional Meeting: Cape Penisular University of Technology
October 10, 2011
Cape Town, South Africa

Hosts: Professor Johan Esterhuizen, Head: Biomedical Sciences
Discussion Leaders: Scott Aikey
Journalist: Carol Jordan

Overview:

The delegation visited the Department of Biomedical Sciences at the Cape Peninsula University
of Technology (CPUT), where our host was, Professor Johan Esterhuizen - a medical laboratory
scientist turned PhD, who heads the department.

CPUT has five campuses and 30,000 students, 500 of which are in the Biomedical Sciences
Department. Eighty of these students are studying for the new Bachelor of Health Sciences
[BHSc] in Medical Technology Degree (versus the B-Tech Degree) which will help to develop
recognition for medical laboratory technologists in South Africa as well as globally. After much
collaboration with several institutions of higher learning, including the University of
Johannesburg, there are currently eight universities in South Africa offering this degree, which is
approved by the HPCSA (Health Professions Council of South Africa), the SMLTSA (Society of
Medical Laboratory Technologists of South Africa) and the NHLS (National Health Laboratory
Service [of South Africa]). This program was developed as a result of a shortage of
technologists, a demand for skills and quality as well as a need for management. Successful
graduates will be called Medical Laboratory Scientists after passing an exam and registering
with the HPCSA. This program is also offered in Namibia and Botswana [with accompanying
exchange programs] and is heavily supported by employers and government subsidies.

A rigorous course of study, there are four levels that each student must achieve: #1-peform, #2-
evaluate, #3-research and #4-manage. Their science courses are not generic and they must do
a case study and a research project while completing their eighteen-month clinical rotation. The
fourth year is for clinical electives and students may specialize in Medical Microbiology,
Virology, Clinical Chemistry, Hematology, Clinical Pathology, Immunohematology, Cytology,
Histology, Cytogenetics, Immunology, Pharmacology, Forensic Medicine or Molecular studies.
There is also a major emphasis on Ethics, which prevails throughout post-graduate Continuing
Education. Another objective of this course is to ensure that after two years of post-graduation
working in the field, technologists are able to open their own labs and do interpretations [not to a
degree to interfere with or negate the role of Pathologists].

Consideration has also been afforded to those technologists, technicians, laboratory assistants
and phlebotomists who are experienced, already registered [from board exam and who have
been working for years. The technologists must do a research project and submit an in depth
resume with a portfolio of evidence. The HPCSA will then decide how they should be
categorized. Currently there are about four technicians to every technologist. Lab assistants and
phlebotomists are also regulated, standardized and registered.


Scott Aikey, Delegation Leader presents a People to People Certificate of Appreciation
to Professor Johan Esterhuizen
Professional Meeting: Pathcare Laboratories
October 11, 2011
Cape Town, South Africa

Hosts: Carol Smith, Laboratory Manager;
Discussion Leaders: Scott Aikey
Journalist: Patricia Jensen

Overview:

Patrick Mulligan founded PathCare Laboratories in 1922. They have 70 consultant pathologists,
110 phlebotomy depots and 60 labs in South Africa. In addition, they have labs in Namibia,
Kenya, Dubai and Nigeria (where they are the major lab in the country.) Some of their historical
milestones include:

1970s started to collect specimens- radio-immunoassay lab in private practice
1975: Computerized lab
1980: Amalgamation of small practice
2000: Automated Microbiology
2005: Robotic auto-chem., immunodiagnostics testing in S. hemisphere
2006: Opened training Academy
2010: PlexID DNA Sequencing Technology: 1st in the world!

The Path Care motto is CARE:
C: Customer
A: Accountability
R: Respect
E: Ethics

Their Strategic Drivers include:
Improving Internal processes and efficiencies
External Alignment
Growth and expansion
Realize values of people
Lean principals apply: pre-analytical, analytical and post-analytical

The Problems with labs are important and want to bring labs to the forefront: We want the world
to know that pathology is important. It was stated that it is very difficult to service the rural
areas and to supply the population with good health care. They attempt to find people who live
in the local/rural villages and pay for their education and training, with the hope that they will
stay in the local villages and provide care to the village. They showed a video of one such
success story.

As far as staffing of their laboratories is concerned, there is a small turnover in the labs: < 5%.
The approximate number of staff is:
Nurses and phlebotomists: ~300
Techs and technologists: ~450
Pathologists: ~70
Curriers: ~170
Debtors staff: ~130
IT Staff: ~30

Pathcare started a Training program in 2006, which was the first in South Africa to be accredited
by the Health Professions Council (HPCSA). There are approximately 200 full time students
enrolled, with 93% of the students from previously disadvantaged backgrounds. They also have
the first recognized Phlebotomy training course in South Africa.

So far, they have 92 Medical Technologists trained in the last 5 years, 116 Technicians and 155
Phlebotomists, which represent 32%, 67%, and 33% of their current workforce!

Pathcare is accredited by SANAS under ISO-17025 & ISO-15189. They were the first lab to be
accredited in Nigeria, Kenya, East Africa and Southern Africa

In addition to providing excellent laboratory services, Pathcare also is committed to Corporate
Social Responsibility, as has a Dare to Care program wherein the staff is involved in the
broader community. Several community events where showcased including Bandana Day
which sought to raise money for the South African Bone Marrow Registry Program.






PathCare Laboratories is truly a state of art reference laboratory with a full specimen processing
robotics line. The delegation was treated to a complete tour of the laboratory.
Cultural Program Johannesburg / Cape Town, South Africa
December 3-13, 2011
Delegation Leader: Scott Aikey


October 3-4, 2011: Arrival and General Observations

Our South African trip of a lifetime started out for many of us on October 2
nd
or 3rd, 2011 when
we all left our home cities to convene in Washington DCs Dulles International Airport. Some
delegates flew in the night before in order to be in Washington DC in time, and others arrived
that day. We all sort of found each other in the gate area. As each new delegate was spotted
with the easy to recognize People to People luggage tags, we congregated together.

The flight to Johannesburg was uneventful, but long. After about 8.5 hours, we landed in Dakar,
Senegal to refuel. Some people got off and others got on, before we took off for our second
8.5-hour flight. By the time landed in Johannesburg, we were all anxious to get off that plane!
We made out way through immigration and headed to baggage claim. Unfortunately, one of our
delegates bags did not arrive with her. Unfortunately, she had to buy some new clothes and
toiletries to make it through the trip.

Once we left baggage and headed out of the airport area, we were met by Mr. Kenny Takalo,
our National Tour Guide who helped us get money exchanged into South African Rand. We
then loaded ourselves and our luggage into the bus and headed for the Southern Sun Grayston
hotel.

The hotel was a beautiful oasis in the heart of the urban city of Johannesburg. Once inside the
hotel, we were greeted with beautiful green grounds, a pool, palm trees, etc. The rooms and
service at the hotel were wonderful. Several of us took advantage and signed up for the
frequent guest program, which afforded us two hours of free Internet service each day during
our stay (which also worked at the Southern Sun hotel in Cape Town.)

We checked into our rooms to freshen up and then met in the restaurant for a dinner buffet.
After dinner, we spread the vast array of professional and personal gifts out and distributed
them into gift bags for each of our professional meetings and personal tokens.


Lots of Luggage at the airport Sorting all of the gifts into bags

October 5, 2011: Delegate Briefing Soweto and Masibambisane Centre

On our first morning in South Africa, we were greeted with beautiful sunshine and brisk
temperatures in the morning yielding to very nice warm weather in the afternoons. Actually, we
couldnt have asked for better weather the entire time we were abroad. We assembled in a
hotel conference room for our orientation and cultural overview. After the required logistical
information was discussed and we all signed up for some additional cultural trips to occur during
our one free day, we settled in to listen to Lizel talk about the country.

We learned a host of things, but most notable to all of us in a healthcare field was the HIV
pandemic that South Africa is dealing with. We learned that although South Africa has 0.7% of
the total world population, they also have 34% of the worlds HIV positive cases. The other
major discussion topic was the countrys Apartheid history. From 1948 through 1994 when the
first democratic elections were held, the country was ruled by the approximately 8% white
population who kept all other races under strict oppression. While there is peace and
democracy today, South Africa does face an issue which threatens the world as a whole,
namely the widening divide between the very rich and the very poor, and the erosion of the
middle class.

Today, South Africa is considered a true Rainbow Nation with a blend of cultures and races
living in harmony. They want the world to see a country of peace and want the world to
understand their past so that it will never happen again.

Later in the day, the delegation toured Soweto, the Southwestern Township of Johannesburg.
Soweto is the largest city within the city of Johannesburg and represents the heart of the
freedom struggle during the Apartheid rule. In addition to Freedom Plaza, the group saw the
homes of Archbishop Desmond Tutu and Nelson & Winnie Mandella.

Before returning the hotel, the group stopped at the Elton John Masibamisame Centre. The
Centre is a non-profit, non-governmental organization for more than 170 orphaned and
vulnerable children. Many of these children are orphans of parents who have previously died of
AIDS. Many of the children are also HIV positive themselves. Mahlako Kotsi, the Centres
Manager and Matome Mokgoloboto, the Centres Program Director met the group and were
treated to a tour of the facility. The delegation was notably generous and brought dozens of
bags of supplies and gifts for the Centre and the children. Once we finished the tour, we
traveled a few blocks to the Community Park and playground where we witnessed the kids from
various Centres playing traditional aboriginal games. The entire visit was truly a blessing as we
saw very happy kids in play even though they seemingly had very little to be happy about.








October 6, 2011: Lesidi Cultural Village

After a day of professional meetings, the delegation visited the Lesidi Cultural Village. Legend
has it that the oldest human skull was found in this area; it is believed that homosapiens as we
know today began in this area of Africa. This Cradle of Humankind is celebrated at Lesidi.
Lesidi is set up similar to the Polynesian Cultural Center in Hawaii where visitors tour through
the five major tribes of old South Africa (Zulu, Pedi, etc.) At each tribal camp, the group learned
about the tribe and their customs and language. For example, if one wanted to marry, one
needed 11 cows to buy the woman. After the tribal tour, the group was treated to a program of
song and dance in Musis Ndebele Theatre. Lastly, a traditional African feast was laid out for
the visitor including Crocodile!


The group learned about the five major tribes of South Africa at Lesidi Cultural Village



October 7, 2011: The Apartheid Museum and Fly to Cape Town

The next three days were a real treat as the program was set up for three days of cultural
program. The group was able to relax and take in all that South Africa had to offer. The
morning of Friday, October 7
th
was solemn. The group visited the Apartheid Museum in
Johannesburg prior to leaving to fly to Cape Town.

The Apartheid Museum is similar to the Holocaust Museum in that is the meant to document the
history of Apartheid along with invoking all the emotions that freely flow from witnessing this
horrific time in history. The first step was entering the museum, which proved to the solemn in
itself. We were randomly given tickets with bar codes. The tickets contained the phrase White
or Non-White; and you had to use the correct line to enter or the barcode would not work. The
exercise, of course, was meant to get you in a frame of mind to fully understand all that was
contained within. Realizing that 8% of the population controlled the rest of the population in
every aspect is a sobering thought. The Museum was set up in chronological order so that you
could walk through South African history starting in the 1940s when the Apartheid regime came
to power through 1994 when the first free elections were held. In addition a special Nelson
Mandella exhibit was on display to chronicle Mandellas life. The first was truly a necessary one
for anyone visiting South Africa. There is no way that you can understand the current cultural
and issues without knowing the past.

The group then flew to Cape Town and checked into the Southern Sun Cape Sun hotel.
Another wonderful National Tour Guide, Steven Lake, met us in Cape Town. There is a stark
contrast between Johannesburg and Cape Town. Johannesburg certainly is the economic hub
of the country, but also has the urban slums and poverty to deal with. Cape Town, at least on
the outside, has all the flair of a Mediterranean city with expensive houses and a beautiful
coastline. The hotel was only a mile or so away from the Waterfront with nice restaurants and
lots of shopping.


At the Apartheid Museum and the White and Non-White entrance.


October 8-9, 2011: A tour of the Cape and a Free Day

Saturday was filled with a complete tour around the Cape Peninsula. Our tour guide Steve had
an unbelievable knowledge base about the Cape, and its flora and fauna. We drove from the
Waterfront around the Cape and saw places such as Table Bay, False Bay, Camps Bay, Haut
Bay and ended in Cape Peninsula National Park for the spot where everyone comes to see
Cape Point, the south western most tip of Africa. We learned that there is a bit of controversy
among purists. That Cape Point is not really the actual point where the two oceans, Atlantic and
Indian, meet, but rather just the two ocean currents. The actual point is 100 miles or so to the
west. Regardless, we all marveled at the ocean, the surf and cliffs and pinched ourselves that
we really were standing on the southern tip of Africa, irrespective of the purists.

After lunch, we stopped at Boulders Beach to visit the African Penguin colony and then headed
up Table Mountain to stop at the Kirstenbosch Botanical Gardens before heading back to the
hotel.

Sunday was a free day. We had several options and most of the delegation chose to take a 45-
minute boat ride out to Robben Island, the island prison where Nelson Mandella was held for 18
years. Others stayed back and shopped in the many shops that were accessible within walking
distance of the hotel.

Robben Island certainly was a treat. Once used as a Leper colony, the island was transformed
into a prison during the Apartheid era. What is unique about the national historical site is that
former guards and prisoners work together today to take people on a guided tour of the island.
Of course the highlight of the tour was seeing the cell where Nelson Mandella was held for 18
years.

Once the group was back to the hotel and together again, we left for the home of Vanessa and
Felicity and were treated to a night full of wonderful food and fellowship. Being of Malay
descent, we were treated to a wonderful Chicken Curry and homemade Malva for dessert. It
truly was a wonderful night where we could relax in a home setting and get to know one
another. We all left with a warm feeling of hospitality that was truly South African.


A tour of Robben Island where Nelson Mandela was imprisoned. In the corner of this courtyard
was where one of Mandelas manuscripts was buried.


A view of Table Mountain from the Southern Sun Cape Sun hotel


Atop Table Mountain with the characteristic table cloth cloud cover

A photo of the delegation along the Cape Peninsula


At the Cape of Good Hope


October 10-11, 2011: Professional Visits

After a few solid days of cultural visits, the next two days were filled with professional visits in
Cape Town. After visiting the Groot Schuur Hospital, the delegation was treated to a tour of the
Heart Museum. The Heart Museum is housed within the old section of the hospital and
showcases the actual Operating Room theatre that was used for the worlds first human heart
transplant in 1967 by Dr. Christian Bernard.



The evening of October 12
th
was our farewell banquet at Robertos restaurant. We were
fortunate to have Steve Lake, our Tour Guide and Nikita, our able bus driver join us along with
several other members of Spirit of Africa and PathCare Laboratories as well.


Robertos Restaurant Steve Lake and Nikita



October 12, 2011: Heading Home or to Kruger

The morning of October 12
th
came very early for 9 of the delegates as we left our Cape Town
hotel and headed for the airport to fly back to Johannesburg. The rest of the delegates had a
leisurely morning and then flew back to Johannesburg on route back to the United States and
then end of their South African Journey. For the rest of us, we certainly had a treat ahead of us.


October 13-14, 2011: Kruger National Park Extension

When we landed in Johannesburg, our third and final National Tour Guide, Liese Mossner-
Sequeira, met us. Liese got us all loaded into the bus and we headed out on the 6-7 hour bus
ride to the northeast coast of South Africa, to Kruger National Park. Along the way, we saw
beautiful mountains and green valleys and eventually came upon the Savannah that is Kruger
and checked into our jungle hotel. Although the hotel is outside the official Kruger Park, and is
surrounded by fences, a number of Bushbok deer and many Vervet Monkeys entertained us on
the ground of the hotel.

Over the next two days, we were treated with unbelievable sights. Of course, everyone wanted
to see the big five (Lion, Leopard, Elephant, Cape Buffalo, and Rhinoceros) but all of the other
animals that we saw were beyond compare as well. Seeing the animals in their natural habitat
was really amazing. Although we didn't see any Leopards, even on our night tour, I think we all
left very satisfied. Our driver, Joanne, was able to answer any question that was posed to her.
During the night tour, we stopped in the bush, got our of our open range vehicle and had
appetizers and drinks while the sun set on the Savannah behind us. Again, someone should
have pinched us so that we really knew that this was not a dream who would have imagined
such beauty.


Ready for our first safari tour

At the Paul Kruger Monument





There really is a Lion under that tree!


Our Tour guide Liese Mossner-Sequeira,




What could be better than sunset in the African bush

October 15, 2011: Heading Home

As the group gathered their bags early on the morning of October 15
th
, we all seemed a little
more solemn that our adventure was coming to an end. It always seems like it takes longer to
get home than it does when you are just starting out on your trip. The 6-7 hour drive back to the
Johannesburg seemed like it took 12 hours; the wait in the airport and then the 17 hour trip back
to Washington DC seemed like it took a week. But I am sure we all dreamed of all of the sights
and sounds that we took in while South Africa as we flew over the Atlantic Ocean back to the
United States. It was a trip of a lifetime, yet I am wondering, when it will be that I can go back
there again soon!


Scott Aikey, MLS(ASCP)
CM
DLM
CM

Clinical Laboratory Science Delegation Leader